Childhood anxiety disorders prevalence in Saudi Arabia

Objectives:To investigate the prevalence of childhood anxiety disorders in Saudi Arabia.Methods:We conducted a cross-sectional study, between September and November 2019, in Saudi Arabia. The study group included the parents of 468 primary school children, aged 6-12 years. Parents completed the Screen for Child Anxiety Related Disorders (SCARED) screening instrument, translated to Arabic. The measured outcome was the prevalence of childhood anxiety disorders, determined from the scores on the SCARED instrument.Results:Childhood anxiety disorders prevalence were as follows: 32.7% had one anxiety, 18.4% had 2, 10.9% had 3, 8.1% had 4, and 7.7% had 5. Of note, 22.2% of children did not have an anxiety disorder.Conclusion:Our results reveal a high prevalence of childhood anxiety disorders among primary school age children in Saudi Arabia. Based on these findings, conducting awareness campaigns and providing educational programs on childhood anxiety disorders might be important to improve the health outcomes of children.     

Evaluation of COVID-19 myths in Saudi Arabia

Objectives:To examine the awareness level of COVID-19 and to highlight the frequency of myths and misconceptions among Saudi Arabia’s population.Methods:We conducted a cross-sectional study from June 13 to 20, 2020 by distributing a 16-item online Google forms questionnaire among adults (18-65 years old) living in Saudi Arabia. We utilized the convenience sampling. Data analysis was performed using Chi-square and multiple regression analysis on Jamovi.Results:A total of 1436 responses were analyzed with 43.5% males and 56.5% females. Most respondents (89.1%) thought that only the elderly above 60 years old are considered at high risk of contracting COVID-19. Most respondents (86.5%) agreed that people with other health conditions could be more affected by COVID-19. Approximately 97.2% agreed that wearing a mask and avoiding touching eyes, nose, and mouth with unwashed hands was the leading preventive action. Most participants (99.4%) chose fever as an associated symptom. Respondents from the healthcare sector presented statistically higher scores than those in non-healthcare sectors (p<0.001). Higher education and higher salary were important predictors of better COVID-19 knowledge.Conclusion:Public health officials need to increase awareness measures on COVID-19 to limit myths and misconceptions and reduce psychological distress associated with it.     

Primary lymphoma of the kidney: Pathology experience from 2 tertiary hospitals in Western Saudi Arabia

Objectives:To document the clinicopathological features of primary renal lymphoma (PRL) at 2 tertiary hospitals in the western region of the Kingdom of Saudi Arabia.Methods:Data were retrieved from all PRLs that were diagnosed at King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia, between January 2002 and April 2022. Histopathological and immunohistochemical slides were reviewed, and additional immunohistochemistry stains were carried out in selected cases. Follow-up data were also collected.Results:There were 17 identified cases of PRL. The age of the patients ranged from 4-76 years (median: 50.5 years and mean: 46.8 years), 11 (64.7%) were males, and 6 (35.3%) were females. There were 12 cases of diffuse large B-cell lymphoma, 3 cases of Burkitt’s lymphoma, and 2 cases of post-transplant lymphoproliferative disorder. The median follow-up duration was 22 months. The one-year overall survival rate was 71% and the 2-year overall survival rate was 43% during follow-up.Conclusion:Primary renal lymphomas in Saudi patients are more common in males and seen in a relatively younger age group compared to the available worldwide data. The diagnosis of PRL is important to avoid tumor dissemination and unnecessary nephrectomy. Diffuse large B-cell lymphoma is the most common pathological type and non-germinal center B-cell is the most common subtype.     

Presentations of active substance use in the emergency department: A single center’s perspective study in Riyadh,Saudi Arabia

Objectives:To explore the most common clinical presentations of active substance users in our institution’s Emergency Department (ED).Methods:This was a retrospective chart review of all patients that were brought to the ED of King Saud University Medical City in Riyadh, Saudi Arabia thought to be actively using illicit substances, between January 2019 and December 2021. Those with incomplete data were excluded.Results:A total of 582 patients were included in the study, 532 (91.4%) males, the majority were in the age group 21-30 years old (53.1%). Most patients were fully alert (n=405, 69.6%). Overall, cannabis was used by 349 (60%) of patients. Seventy-four patients presented to the ED because of motor vehicle collisions, the majority were males (98.6%), 35 (47.3%) were the driver of the vehicle and 40 (54.1%) were on cannabis. Males had 5.5 times more medical illness presentations and 10.8 times traumatic illness presentations when compared to females predominantly presenting with psychological illness presentations.Conclusion:Among Saudi users of illicit substances, the majority were young men with medical illness presentations. The rate of traumatic injuries / vehicular and road traffic accidents is at 15.3%, and cannabis and amphetamine were the most used substances. Screening for active substance use should be conducted using both patient histories and laboratory testing for all high-risk presentations and not solely based on clinical assessment.     

Assessment of dermatologists’ perception of utilizing teledermatology during COVID-19 pandemic in Saudi Arabia

Objectives:To assess teledermatology (TD) perception among dermatologists in the Kingdom of Saudi Arabia during the COVID-19 pandemic and to identify the most common advantages and disadvantages of TD.Methods:We conducted a cross-sectional survey-based study to address Saudi dermatologist perceptions of TD from July 2020 to December 2020, during Covid-19 pandemic.Results:Out of 664 emails sent, 107 complete responses were returned. Approximately 40.2% used TD through phone calls, followed by those who used a virtual clinic (32.7%). Also, the best way to use TD, according to respondents, was for triage before inpatient and outpatient visits. When we compared the use of TD in the outpatient and inpatient settings, outpatient responses always had more positive attitudes than inpatients. The most important benefit of TD is to reduce the risk of pandemic infections (69%). More than half of the participants sometimes used TD for diagnosis (n=63, 58.9%) and management (n=59, 55.1%), and 69 (64.5%) considered using it in the future.Conclusion:Our survey-based study indicates that TD is an important part in the future dermatology because our participants agreed that TD decreases cost, increases access to dermatology care, and reduces the risk of pandemic infections. And it is necessary to establish an infrastructure for TD that protects patient’s privacy and ensures accurate diagnosis.     

Genotyping of Dombrock blood group system in blood donors from Saudi Arabia: A single-center study

Objectives:To establish the frequency of Dombrock (DO) blood group genotypes in Western Saudi Arabians and to compare the findings with other populations in the 1000 genomes database.Methods:This cross-sectional study was carried out between December 2018 and February 2019. A total of 440 blood samples in ethylenediaminetetraacetic acid tubes were collected from unrelated Saudi Arabian blood donors from Jeddah, Saudi Arabia. Deoxyribonucleic acid was extracted, followed by an allele-specific polymerase chain reaction for DO*01 and DO*02 alleles (c.793A>G, rs11276). The allele and genotype frequencies were counted and compared to those in other populations using the Chi-squared test with Bonferroni adjustments.Results:The DO allele frequencies for blood donors from western Saudi Arabia were 0.432 for DO*01 and 0.568 for DO*02. The DO genotype frequencies were 0.182 for DO*01/01, 0.318 for DO*02/02, and 0.5 for DO*01/02. The DO genotype frequencies were similar to Europeans, Americans, and South Asians but significantly different from the genotype frequencies of Africans and East Asians reported in the 1000 genomes database.Conclusion:Dombrock genotype frequencies in the Western Saudi Arabian population were different from Africans and East Asians but not from Europeans, Americans, and South Asians. This study contributes to a genotyped blood donor database and may advance transfusion safety for patients in western Saudi Arabia.     

Clinicopathological features and prevalence of prostate cancer in Aseer,Saudi Arabia

Objectives:To determine the prevalence and characterize prostate cancer (PC) cases in Aseer, Saudi Arabia.Methods:This study involved 883 patients who consulted physicians in Aseer Central Hospital, Abha, Saudi Arabia, for prostate issues between the years 2008-2018. All patients underwent digital rectal examination and measurement of their serum prostate-specific antigen levels. For patients who presented abnormal digital rectal examination findings and elevated prostate-specific antigen levels, prostate biopsies were recommended. Specimens were histopathologically examined to differentiate between malignant and benign tumors.Results:Among the 883 included patients, 132 (15%) underwent a prostate biopsy and were found to have a tumor. Histopathological examination confirmed malignancy (PC) in 77 (8.7%) patients. The absolute majority of the patients diagnosed with PC (96%) were aged >60 years and almost all of them (92%) were found to have a high prostate-specific antigen level of >4 ng/ml.Conclusion:Prostate cancer appears to be a serious disease in Aseer, Saudi Arabia. Further studies aimed at determining the causes of this type of cancer and understanding its mechanisms are warranted.     

Guidelines for cochlear implantation in Saudi Arabia

This study aim to establish unified clinical practice guidelines (CPGs) for adults and pediatric cochlear implantation (CI) for the Ministry of Health specialist hospitals in the Kingdom of Saudi Arabia. A comprehensive literature review was carried out by a task force group. Guidelines were based on evidence-based medicine including institutions and individuals’ experiences. Bilateral CI is recommended for adults and pediatrics with bilateral severe/profound hearing loss. The minimum age of implantation for children is recommended at 9 months. This study provides a safe framework for the multidisciplinary team to select appropriate CI candidates. It is important to establish a comprehensive multidisciplinary team covering different aspects of health care providers.     

Cytological patterns of thyroid lesions in Najran,Saudi Arabia: A 5-year retrospective study

Objectives:To assess the cytological pattern of thyroid lesions in Najran, Saudi Arabia.Methods:A retrospective study, from the period of January 2015 to December 2019. All patients with thyroid enlargement who were presented to different hospitals in Najran and assessed by fine needle aspiration cytology were included in this study.Results:Of 1353 cases, 1138 (84.1%) were female and 215 (15.9%) were male. Most of the thyroid lesions were benign (72.5%) including follicular nodules (39.5%), Hashimoto’s disease (21.2%), and colloid nodules (11.8%). There were 107 (7.9%)cases of suspicious malignancy, and the most common malignant tumor was papillary carcinoma (10.2%). The 2^nd age group (21-40 years) was the common age to be diagnosed with malignant tumors, particularly in males. The 3^rd age group (41-60 years) was most affected by thyroid lesions, particularly in females.Conclusion:Most of thyroid lesions in Najran were benign, and females were more affected by thyroid lesions than males. However, papillary carcinoma was the 4^th most frequent thyroid lesion in females, while it was the 2^nd most frequent in males and diagnosed mainly in younger males (21-40 years). Finally, ages 21-60 years were associated with most of the thyroid lesions in both males and females.     

Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia

The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country’s high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a significantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.     

The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia: Findings from a level-I trauma center

ABSTRACTObjectives:To investigate the incidence and predictors of traumatic pneumothorax using data from a Level-I trauma center in Riyadh, Saudi Arabia.Methods:This is a retrospective chart-review study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Data were extracted from the hospital’s trauma registry (2016-2018). A total of 2,109 trauma patients were included. Inclusion criteria were patients ≥16 years old admitted for a traumatic injury. Variables included patient demographics, transport mode, trauma team activation, mechanism of injury, mortality rate, Glasgow Coma Scale and Injury Severity Scores. A logistic regression analysis was constructed to evaluate potential predictors of pneumothorax.Results:Of 2,109 patients included from the trauma registry, 236 (11.2%) were diagnosed with pneumothorax. The majority of the study population was young (19-49 years) (60.7%) and male (79.4%.) Injury mechanism was significantly associated with the presence of pneumothorax (p<0.001). Regression analysis indicated that the odds of having pneumothorax among intentional injury victims was 15 times higher than fall injury victims (OR=15.3, 95% CI= 7.2-32.9). Participants who sustained motor vehicle collision injuries had 3 times higher odds of developing pneumothorax than those who suffered fall injuries (OR=3.1, 95% CI= 1.5-6.1).Conclusion:The incidence of traumatic pneumothorax is sizable and highly associated with the mechanism of injury. Efforts to reduce motor vehicle collision burden should be directly associated with decreasing the burden of traumatic pneumothorax.     

Public knowledge,perception, and experience with generic medications in Saudi Arabia

Objectives:To assess the public knowledge and perception about generic medications in Saudi Arabia, and their willingness to use generic medications.Methods:This cross-sectional, online-questionnaire-based study was conducted between May and July 2019, including participants who can read and complete an Arabic online survey. Chi-square test and contingency coefficient were used to investigate differences in different segments of participants and assess the association between knowledge and perception.Results:A total of 397 participants have completed the survey. One-half of them were female, the majority were of young age (<35 years), and 40% of them were buying their medications independently. Only 40.5% of participants had adequate knowledge and 60% of them had positive perception on generics. Participants with higher level of education were more likely to have adequate knowledge (p=0.002) and positive perception (p=0.006). The study found a moderate relationship between knowledge and perception about generics (standardized C=0.35, p<0.001). The country of origin for medications was a significant indicator of quality for two-thirds of participants, and one-half of them believed that local generics can compete with imported ones. About one-half of participants used generics and the majority of them were satisfied with their experience.Conclusion:There is a general lack of knowledge, while having a positive perception on generic medications among the general public in Saudi Arabia. Future studies should focus on strategies to improve it and assess its cost-savings consequences while maintaining quality of care.     

Quality of life in vitiligo patients in central Saudi Arabia

Objectives:To assess the quality of life (QoL) in patients with vitiligo in central Saudi Arabia using the dermatology life quality index (DLQI).Methods:A cross-sectional study spanning over 6 months was conducted on 253 adult patients with vitiligo at the outpatient dermatology clinics of the National Center of Vitiligo (Light Clinics) and King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were asked to complete a self-administered questionnaire using an Arabic version of the DLQI to measure the impact of vitiligo on their QoL. The association between the demographic and diseases characteristic to the median DLQI scores was investigated using binary logistic regression.Results:The median DLQI score was 4, the range 25, min 0 - max 25 and percentiles 2-8. The unadjusted odds ratio (95%CI) showed the median DLQI score was significantly higher in married subjects 2.29 (1.33-3.94) (p<0.01), non-segmental vitiligo 2.10 (1.16-3.79) (p<0.01), and the progressive vitiligo 1.87 (1.09-3.18) (p<0.02) than their counterparts. However, after adjustment only married status predicted the high DLQI score 2.08 (1.11-3.61) (p<0.01).Conclusion:The QoL in vitiligo patients in Saudi Arabia is adverse than those with lighter skin, in other countries. Therefore, in Saudi Arabia, better management modalities to improve patients’ QoL and prevent subsequent mental distress are needed.     

Clinical and epidemiological characteristics of COVID-19 mortality in Saudi Arabia

Objectives:To analyze the clinical and epidemiological characteristics for 224 of in-hospital coronavirus disease 2019 (COVID-19) mortality cases. This study’s clinical implications provide insight into the significant death indicators among COVID-19 patients and the outbreak burden on the healthcare system in the Kingdom of Saudi Arabia (KSA).Methods:A multi-center retrospective cross-sectional study conducted among all COVID-19 mortality cases admitted to 15 Armed Forces hospitals across KSA, from March to July 2020. Demographic data, clinical presentations, laboratory investigations, and complications of COVID-19 mortality cases were collected and analyzed.Results:The mean age was 69.66±14.68 years, and 142 (63.4%) of the cases were male. Overall, 30% of the COVID-19 mortalities occurred in the first 24 hours of hospital admission, while 50% occurred on day 10. The most prevalent comorbidities were diabetes mellitus (DM, 73.7%), followed by hypertension (HTN, 69.6%). Logistic regression for risk factors in all mortality cases revealed that direct mortality cases from COVID-19 were more likely to develop acute respiratory distress syndrome (odds ratio [OR]: 1.75, confidence intervel [CI: 0.89-3.43]; p=0.102) and acute kidney injury (OR: 1.01, CI: [0.54-1.90]; p=0.960).Conclusion:Aging, male gender and the high prevalence of the underlying diseases such as, DM and HTN were a significant death indicators among COVID-19 mortality cases in KSA. Increases in serum ferritin, procalcitonin, C-reactive protein (CRP), and D-dimer levels can be used as indicators of disease progression.     

Clinicopathological characteristics of young versus older patients with breast cancer: A retrospective comparative study from the Madinah region of Saudi Arabia

Objectives:To compare the clinicopathological, histological and immunohistochemical features of breast cancer (BC) in between young (≤40 years) and older (>40 years) patients.Methods:This retrospective study included histopathological reports of all patients with primary BC diagnose at the King Fahad Hospital, Madinah, Saudi Arabia between January 2006 and November 2020.Results:During the study period, a total of 708 patients with BC were identified; 173 cases (24.4%) were ≤40 years old and 535 (75.6%) were above 40 years. There were significant differences in tumor size (p=0.046), tumor grade (p<0.0001), tumor stage (p=0.047), lymphovascular invasion (p<0.0001), and distant metastasis (p<0.0001) between the 2 groups. Comparing the status of the hormone receptors and molecular subtypes between the 2 age groups, BCs in the younger patients were triple–negative (p=0.008) in majority of the cases and less likely to be estrogen receptor (ER) and progesterone receptor (PR) hormone receptors–positive (p=0.0001, p<0.0001). Young patients exhibited the HER2/neu type with more frequent statistical significance (p=0.016) and the tumor type luminal A (p=0.002) with less frequent statistical significance compared to old patients.Conclusion:Although BC in young women is uncommon, it may be different with regards to poor prognostic outcomes, which are attributed to more aggressive histopathological features and less favorable receptor status when compared to the cases diagnosed in older women.     

Clinical characteristics and in-hospital mortality of COVID-19 adult patients in Saudi Arabia

Objectives:To provide a detailed study of demographic, baseline comorbidities, clinical features, and outcome for Coronavirus disease 2019 (COVID-19) patients.Methods:A record-based case-series study conducted from March 23 to June 15, 2020 in King Saud Medical City, Riyadh, Saudi Arabia. Demographic data, clinical presentation, laboratory investigations, complications, and in-hospital outcome of COVID-19 patients collected with analysis of the clinical characteristics for survivors and deceased.Results:A total of 768 patients were included. The mean age was 46.36±13.7 years and 76.7% were men. Approximately 96.3% reported more than one comorbidity; diabetes mellitus was the most frequent (46.4%). Fever (84.5%), cough (82.3%), and shortness of breath (79.8%) were the main presenting symptoms. During the follow-up, pneumonia reported in 68.6%, acute respiratory distress syndrome in 32.7%, septic shock in 20.7%, respiratory failure in 20.3%, and acute kidney injury in 19.3%. Approximately 45.8% of enrolled patients required intensive care unit admission. Lung disease (odd ratio [OR]=3.862 with 95% confident interval [CI] (2.455-6.074), obesity (OR=3.732, CI=2.511-5.546), smoking (OR=2.991, CI=2.072-4.317), chronic kidney disease (OR=2.296. CI=1.497-3.521), and diabetes mellitus (OR=2.291, CI=1.714-3.063) are predictors of ICU admission. Fatality ratio was 89/2084 (4.27%). Men were more prevalent in dead group.Conclusion:Coronavirus disease 2019 places a huge burden on healthcare facilities, particularly in patients with comorbidity. Coronavirus disease 2019 patients who are obese and smokers with history of diabetes mellitus have a high risk of death.     

The prevalence of cardiovascular disease in adults with type 2 diabetes mellitus in Saudi Arabia - CAPTURE study

Objectives:To investigate cardiovascular disease (CVD) prevalence in adult patients with type 2 diabetes mellitus (T2DM) in Saudi Arabia using data from the CAPTURE cross-sectional study.Methods:CAPTURE was a non-interventional, multinational study carried out between December 2018 and September 2019. In Saudi Arabia, clinical (including medication) and demographic data were collected across 7 sites (Alhada Armed Forces Hospital, Taif; King Saud University Medical City, King Saud University, Riyadh; Specialized Medical Centre Hospital, Riyadh; King Abdulaziz University Hospital, Jeddah; King Abdulaziz Hospital for National Guard, Al Ahsa; Diabetes and Endocrinology Center, Buraidah; and Dallah Hospital, Riyadh, Saudi Arabia) from adults aged ≥18 years. The prevalence of CVD was estimated and weighted according to care setting, with data between groups not statistically compared.Results:Among the 883 adults enrolled in this study (566 from primary care, 317 from secondary care), 158 had established CVD, making the weighted prevalence of 18% (95% CI: [15.5-20.5]). The weighted prevalence of atherosclerotic CVD was 15.1% (95% CI: [12.8-17.5]), accounting for 82.4% of the CVD cases. Coronary heart disease was the most common subtype of CVD (13.4%), followed by cerebrovascular disease (1.7%). A total of 23.6% of patients were treated with glucose-lowering agents with proven cardiovascular benefit.Conclusion:In Saudi Arabia, approximately one in 5 adults with T2DM had established CVD, lower than the global prevalence, possibly because of disparities in patient characteristics, potential genetic predispositions, or a lack of accurate documentation due to poor coordination between care settings.